A medical expense policy contains a standard list of exclusions. Which type of care is most commonly excluded from coverage?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Medical expense policies are designed to pay for the diagnosis and treatment of illness and injury. Custodial care, which consists mainly of assistance with daily living such as bathing, dressing, and eating, does not treat or cure a condition and is therefore excluded from most major medical plans. The exclusion appears in the policy's list of exclusions and limitations and is a common exam point. Custodial care is typically the province of long-term care insurance rather than medical expense insurance. Emergency services, surgery, and physician visits are all core covered services, which is why they do not appear as exclusions.
Why the other options are wrong
- B) Emergency room services for a heart attack are emergency medical care and are covered, often with a copayment or coinsurance.
- C) Outpatient surgery is a medically necessary treatment and is a covered benefit under a major medical policy.
- D) Physician office visits for an acute infection are diagnosis and treatment and are covered as medical care.
Memory hook
Medical pays to heal you; custodial care only helps you live, so it is the classic exclusion.